I recently talked with Costa about rabies, the woman who survived it, and why it might make sense in some parts of the world to vaccinate children.

Rabies is fully preventable, so why do 55,000 people die every year from it?

The number one reason people continue to die is [lack of] general awareness—of the need to vaccinate animals; what to do if they’re bitten by a dog; and awareness of what to do as far as primary wound care.

One of the issues is the expense of these biologicials and the distance some families have to travel to receive these biologicials. Rabies post-exposure treatment is four treatments over four weeks. Often times families are traveling by foot, and it’s difficult for them to make all those trips.

And sometimes an entire family may be exposed to a rabid dog or a rabid animal, and often times due to the expense, families have to decide which family member they’re going to treat, which is just unconscionable, but these are the reasons people continue to die from rabies.

In terms of rabies mortality, 55,000 is an underreported number. In Asia and Africa where most of the cases occur, we don’t have very good surveillance and laboratory technology. So if someone is bitten by a dog, they can’t test the dog and figure out if the dog had rabies.

What’s the situation in the U.S.?

Globally, tens of millions of people are exposed, and tens of thousands of deaths occur around the world, with dogs the leading culprit. In the U.S. there are 20,000 to 40,000 human exposures every year, which equals one to five human deaths annually, and wildlife is the main culprit. So 99.9 percent of cases around the world are from dog bites, but that’s not the case here, because we have mandatory vaccination laws [for dogs], mandatory reporting laws and decentralized laboratory system. We have over 100 diagnostic laboratories. It’s different in other countries. There’s maybe one centralized lab for an entire country. We have an incredible public health system in the U.S. We have rules for this, and most importantly, we’re educated about rabies, what the disease is and where it comes from.

There are 7,000 to 10,000 cases a year in animals--we see bats, skunks, raccoons. The CDC reports cases in every state except Hawaii. Of domestic animals tested in 2009, there’s actually four times the number of cats reported rabid than dogs. A lot of cat owners think cats don’t need to be vaccinated for rabies because they’re indoor cats, but sometimes they get out.

The vaccination isn’t required for cats?

It does not have the same mandatory vaccination requirements blanketed across the U.S. as it does for dogs.

USDA just reported in 2007, 27 percent of households in the U.S. had 1.7 animals. These domestic animals we keep as pets serve as the firewall—the link--between wildlife and humans. So it’s important we vaccinate our animals for themselves as well as for us.

Does the disease affect animals and humans differently?

There's probably subtleties in the behavior change, but the best way to look at it is when abnormal behavior becomes normal. We’ve all heard, “Raccoon during the day, stay away.” For the most part, if you see a wild animal and it’s not afraid of you, that’s a sign. Any mammal that contracts the disease will invariably die.

The biggest thing with rabies is that unlike other diseases, once you have symptoms, you’re going to die. There’s no way to know whether you have the disease. Once you have clinical symptoms, you’re on a fatal course, and it’s already replicating within the central nervous symptom. There’s no warning sign that it’s about to settle. Once it’s settled in, there’s nothing to be done.

So nobody has survived rabies?

We do have one rabies survivor—Jeanna Giese in Wisconsin. We work closely with her. We invite her on our rabies outreach. She’s the only known survivor to rabies without being previously vaccinated. She’s experienced a lot of other issues. She’s not fully recovered. She contracted the disease and began showing symptoms before she could receive treatment. But finally when she went to the doctor in Milwaukee and they ruled she was positive for rabies, they went into experimental mode with what is now called the Milwaukee protocol. She’s a miracle; other than her, it’s 100 percent fatal… and 100% preventable. Rabies continues to have the highest case fatality rate of any disease.

I had a vaccine for rabies once before I went camping in South America, but other than cases of traveling and working with animals, is the vaccine being used as a preventative measure with humans?

Certainly those working with animals or who could be exposed to the virus in a laboratory setting should receive pre-exposure.

They’re also looking at using pre-exposure in areas that are highly endemic—for children that are most likely to be exposed to a roaming dog. We don’t think that’s necessarily the answer, but it is an instrument in our toolbox. Vaccinating dogs is the number one way to prevent human rabies.

What else should we know about rabies?

One of the myths is that rabies is rare or that it doesn’t exist anymore. Our public health system has done a tremendous job when we look at mandatory vaccination laws and making sure that animal bites are reported and that animal testing is done. And then we treat humans if necessary. What we need to know is that it’s still in our backyard. We need to know that vaccinating our dogs, cats and ferrets in our house is in the animal’s best interest and in the owner’s best interest.

We’re talking about bites, but we’re also talking about any contact saliva from a rabid animal could have with an open wound—even a scratch from a cat.

Anyone who is bitten by an animal, the first step is to wash the wound. It’s arguably the most important step. Wash it with soap and water for five to 10 minutes. If you have a county or municipal health department, report the bite, and depending on the risk assessment at that point, there will be a decision on treatment.